6. Project Summary/Abstract On September 2017, Hurricanes Irma and Maria devastated the Caribbean region, particularly the US territory of Puerto Rico (PR) causing widespread destruction and resulting in massive resource losses and economics costs. Critical acute issues caused by this catastrophe mirrored those caused by other disasters worldwide. Health-related issues include problems with sanitation and hygiene, water safety, infection control, immunizations, and access to care. Historically, studies in the aftermath of hurricanes and other natural disasters has focused on environmental risk factors, infectious diseases, physical hazards and mental health. Nonetheless, despite of the burden of cancer worldwide and the exacerbation of chronic diseases in the aftermath of natural disasters, few studies have assessed the impact of natural disasters on cancer, especially those on active treatment, which can have weakened immune systems and may be at higher risk for infections, bleeding, fatigue, and injury. Moreover, it remains uncertain the impact of natural disasters on among cancer patients especially those with breast and colorectal cancer, two of the most common cancers for both incidence and mortality in PR. Breast and colorectal cancer treatment require a series of coordinated services that are susceptible to a catastrophic event. Studying the effects of Hurricanes Irma and Maria on cancer treatment is relevant and of prominent importance for public health since it will have significant consequences to the health care system, since delay in cancer treatment might result in a poorer quality of life, spreading of the tumor, the need for more extensive therapy and ultimately poorer survival. The overall goal of this study is to employ a multilevel mixed-methods approach to identify individual and contextual factors leading to disruption and continuation in cancer care in the aftermath of this unprecedented events. We will collaborate with the the PR Central Cancer Registry, a North American Association of Central Cancer Registries (NAACCR?s) Gold Certificated registry, and one of the oldest registries in America, to: (1) identify barriers and facilitators related to disruption and continuation in cancer care in the aftermath of Hurricanes Irma and Maria through key informants interviews and focus groups with breast and colorectal cancer patients, and (2) evaluate factors associated with cancer care disruption in the aftermath of Hurricanes Irma and Maria among 600 breast and colorectal cancer patients using a telephone-based interview. If granted, this project will provide the opportunity to collaborate with national experts in the field of disasters and health, will serve to inform via an academic-community forum to governmental, professional, community-based and humanitarian organization in the island, as well as emergency responders and clinicians how best to support and potentially mitigate the burden of cancer patients on treatment after a future major natural disaster.